Title : Can pre-operative patient factors predict permanent pacemaker implantation after Coronary Artery Bypass Grafts (CABG)?
Abstract:
Approximately 1% of patients who undergo coronary artery bypass graft surgery (CABG) may require permanent pacemaker implantation (PPMI). Previous studies have investigated risk factors for PPMI including age, sex and the presence of renal disease. However, we wished to focus on the potential influence of pre-operative cardiac status.
We undertook a retrospective review of all patients who underwent isolated CABG between 1999 and 2020 in a tertiary referral cardiothoracic surgical department of Castle Hill Hospital, Hull, United Kingdom. The data was taken from a large hospital registry. We excluded patients with preoperative complete heart block or pacemaker in situ and identified those who had PPMI in hospital postoperatively. We analysed the data using IBM SPSS Statistics Version 27.
Of the total 8073 patients who underwent isolated CABG surgery during this period, 7881 did not require PPMI after surgery. 115 were excluded due to having a pacemaker in situ before the operation and 10 due to pre-operative heart block. 67 patients (0.85%) required PPMI after surgery. Predictors for PPMI post CABG were preoperative arrythmia (p<0.001), number of previous myocardial infarction (MI) (p<0.001), unstable angina within 30 days (p<0.001) and the extent of coronary artery disease (p=0.025).
Our findings demonstrate that the risk of PPMI can be predicted by several indicators of cardiac disease pre-operatively. We recommend that this risk should be addressed in the preoperative assessment to tailor the consenting process to the patient. We feel this has a potential role in developing a more patient centered approach and could lead to a better understanding of post-surgical risk for both clinician and patient.
What will audience learn from your presentation?
- Pre-operative patient factors influence their risk of requiring a permanent pacemaker after coronary artery bypass grafts.
- This research provokes further work to develop a risk prediction model to tailor quoted risks to individual patients.
- This proposes a patient centered approach to consent and risk management; studies such as these could improve shared decision-making in the pre-operative period.
